Gladskikh Tatiana/Shutterstock.com

Hormonal changes during menopause can drive suicidal thoughts – a crisis that healthcare services have failed to recognise or adequately address. The devastating link is laid bare in research my colleagues and I conducted recently.

The study, which involved interviews with 42 women who experienced suicidal thoughts and behaviour during perimenopause or menopause, exposes a troubling pattern. Women in crisis are being prescribed antidepressants instead of hormone replacement therapy (HRT), despite clear menopause guidelines stating that antidepressants should not be a first-choice treatment for menopause-related low mood.

Over the past two decades, suicide rates have climbed among women in their mid-40s to mid-50s – precisely the age when most experience the menopausal transition. Yet the role of hormonal changes in this mental health crisis has been largely ignored.

Women in the study described feelings of profound hopelessness and entrapment. One participant said: “What’s the point in being alive? What purpose, what function do I have? I’ve got nothing left to give, nothing left to contribute. Why am I still here?”

The perimenopausal depression they described went beyond ordinary low mood, encompassing crushing fatigue, a sense of worthlessness and the feeling of being a burden to loved ones. Many questioned whether their lives had any remaining value or purpose.

A healthcare blind spot

The research revealed alarming gaps in medical knowledge and care. Women reported lengthy delays in receiving appropriate hormone replacement therapy (HRT) and frequent misdiagnoses. Many said their GPs lacked a basic understanding of how hormones affect mental health.

“There was zero knowledge about hormones,” one woman said of her GP. “They were doing their best with what they felt they knew, but they didn’t know anything about this subject whatsoever. It’s not on their assessments to ask about women’s menstrual cycles.”

Even when women explicitly requested hormone treatment, some were refused due to a rigid interpretation of clinical guidelines. Research shows that antidepressants are being prescribed disproportionately to women – a pattern that, in some cases reported in the study, worsened symptoms rather than relieved them.

Woman putting an HRT patch on her upper arm.
Women reported delays in receiving hormone replacement therapy. Andrey Popov/Shutterstock.com

The hormonal upheaval of menopause doesn’t occur in isolation. In midlife, women often juggle caring responsibilities, career pressures and domestic demands. These are pressures that layer on to the biological changes they’re experiencing, creating an intense mix of physical and emotional strain.

Women are now widely recognised to be losing jobs, relationships and, in some cases, their capacity to make decisions due to menopausal symptoms. Mood swings, anxiety, brain fog, hot flushes and feelings of profound sadness can be debilitating. Yet, for many, these symptoms are dismissed or misunderstood.

This dismissal has deep historical roots. The outdated diagnosis of female “hysteria” – a misogynistic label used to pathologise women’s emotions – once justified treatments as extreme as asylum confinement and electroconvulsive therapy. The word may be gone, but its legacy endures in the way women’s hormonal suffering is still minimised as exaggeration or overreaction.

There are signs of change. In 2021, an independent UK government report made ten recommendations to support menopausal women in the workplace and beyond. And, in November 2024, clinical guidelines were updated to recommend psychological support for women experiencing early menopause.

But suicide risk for midlife women has not been adequately highlighted in menopause guidance – a gap that urgently needs addressing.

Many women in the study reported dramatic improvements in mental wellbeing and a reduction in suicidal thoughts after receiving timely HRT and support from healthcare professionals who actually listened. Some described their lives as becoming tolerable again after years of suffering.

Not all women will benefit from hormone replacement, but all deserve to have their hormones checked and to be offered treatment when appropriate. The choice should be theirs – informed, supported and taken seriously.

The silence around menopausal mental health has lasted too long. It’s time healthcare services recognised this crisis for what it is: a matter of life and death.

This article is republished from The Conversation, a nonprofit, independent news organization bringing you facts and trustworthy analysis to help you make sense of our complex world. It was written by: Pooja Saini, Liverpool John Moores University

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Pooja Saini is affiliated with NHS organisations, charities and non-for profit organisations.